Elucidating system-level interdependence in electronic health record data: What are the ramifications for trainee...

Area of Science:

• Medical Education
• Health Informatics
• Clinical Assessment

Background:

• Electronic health records (EHR) offer potential for collecting clinical performance data on trainees.
• Current EHR data is not organized for trainee assessment purposes, necessitating a structured approach.
• Understanding how to utilize EHR data for meaningful assessment and feedback is crucial.

Purpose of the Study:

• To identify EHR performance metrics reflecting both independent and interdependent clinical performance of emergency medicine (EM) trainees.
• To explore the meaningful application of these EHR metrics for trainee assessment and feedback.

Main Methods:

• Constructivist grounded theory approach.
• Conducted 21 semi-structured interviews with EM faculty and residents.
• Iterative data collection and analysis involving three stages of coding.

Main Results:

• Faculty and trainees expressed support for EHR metrics in principle but concern over representativeness of individual performance.
• Identified three categories of system-level interdependence: medical directives, technological systems, and organizational systems.
• Explored strategies used by participants to navigate system-level interdependence.

Conclusions:

• System-level interdependence significantly shapes physician performance but is often unacknowledged in clinical data.
• Educators must recognize and incorporate system-level interdependence into teaching and assessment strategies.
• Fair and effective utilization of EHR data for trainee assessment requires accounting for collaborative and systemic factors.